By Ed Coghlan
The debate over the prescription of opioids to treat chronic pain surfaced again this week.
Research is out showing that opioids are contributing to more heart-related and other deaths?
Patients who use opioids had a 64% higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine.
The study was published in the Journal of the American Medical Association this week.
Lead author Wayne Ray, Ph.D., and colleagues with the Vanderbilt Department of Health Policy studied 45,000 Tennessee Medicaid patients between 1999-2012 with chronic pain, primarily back and other musculoskeletal pain, who did not have cancer or other serious illnesses. The study authors noted that the body’s prolonged exposure to the drugs may increase risks for toxic reactions.
Researchers compared those starting a long-acting opioid to those taking an alternative medication for moderate-to-severe pain.
Alternative medications included both anticonvulsants — typically prescribed to prevent seizure activity in the brain, treat bipolar disorder or neuropathic pain — and low doses of cyclic antidepressants, which are taken for depression, some pain and migraines.
“We found that the opioid patients had a 64 percent increased risk of death for any reason and a 65 percent increased risk of cardiovascular death,” said Ray, professor of Health Policy at Vanderbilt University School of Medicine.
“The take-home message for patients with the kinds of pain we studied is to avoid long-acting opioids whenever possible. This is consistent with recent Centers for Disease Control and Prevention guidelines. This advice is particularly important for patients with high risk for cardiovascular disease, such as those with diabetes or a prior heart attack.”
If a long-acting opioid is the only option for effective pain relief, patients should start with the lowest possible dose and only gradually increase it, he said.
This study comes as the federal government continues to ratchet up attention on what it believes to be the dangers of opioids.
The Centers for Disease Control developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings.
The Guideline, which was finalized in March of this year, has divided much of the pain community. A sizeable (and very frustrated) portion of the pain community believes that the government’s concern over the prescription of opioids is hurting patients who take them responsibly to treat their pain, often intractable chronic pain.
Others are concerned at the prescribing practices of mostly family practice physicians.